Hillary Clinton on Health Care

Secretary of State; previously Democratic Senator (NY)

The science is clear: vaccines work

As the latest measles outbreak raises alarm, the vaccination controversy is a twist on an old problem for the Republican Party: how to approach matters that have largely been settled among scientists but are not widely accepted by conservatives.

Hillary Clinton weighed in with a jab at vaccine naysayers: "The science is clear: The earth is round, the sky is blue, and vaccines work."

Howard Dean, a presidential candidate in 2004 and a former DNC chairman, said there are three groups of people
who object to required vaccines: "One is people who are very much scared about their kids getting autism, which is an idea that has been completely discredited. Two, is entitled people who don't want to put any poison in their kids and view this as
poison, which is ignorance more than anything else. And three, people who are antigovernment in any way."

"But the truth," added Dean, a physician, "is you can be conservative without putting kids in harm's way."

Ebola won't stay confined; put resources into Africa

Former Secretary of State Hillary Clinton claimed Ebola is "not going to stay confined" in a speech she gave to the UNLV Foundation in Las Vegas. "Ebola, as we're seeing very painfully,
is not going to stay confined unless we put in a lot more resources to try to begin to tailor down the epidemic and contain it and end it the way we have previously by putting in a lot of resources. So, it's not either/or.
We can't say we're not going to be involved because these things are somebody else's problems because in the world of inter-dependence that we currently live in,
a lot of those problems end up eventually on our doorstep," Clinton said.

Don’t legitimize end-of-life decision, but ok to help decide

Q: Do you believe it is compassionate, that it is appropriate to let someone who is really suffering choose to end their life?

A: This is one of those incredibly challenging issues. You know, the Terry Schiavo case posed that for many people. There wer
people of good faith on both sides about what should happen to that woman’s life. And I don’t know that any of us is in a position to make that choice for families or for individuals, but I don’t want us also to condone government action that would
legitimize or encourage end of life decisions. Somehow there has to be a framework for us to determine: How can people who are able to make these decisions on their own do so? Or if they are not, how best do we create a decision process for their
families to try to decide? And now we are being faced with a lot of these difficult decisions because of what the world we live in today with modern technology and so much else. And we’re going to have to come to grips with them one way or another.

Decrease generic drug costs for developing countries

Q: Current US trade policies toward developing countries make it sometimes extremely difficult for poor people to access inexpensive, generic drugs for the treatment of AIDS and other sicknesses. How would you shape this policy?

A: I believe that our
government must do so much more to get generic drugs and low-cost drugs to people suffering. Not only from HIV/AIDS, but the range of diseases that affect disproportionately the poor. Our great pharmaceutical companies invent the compounds and put them
together that the generics then are able to copy. But we need to do much more to get our pharmaceutical companies to work with us to get the drug costs down and to open the pathway for generic drugs. And that’s going to take presidential leadership.
I commend Pres. Bush for his PEPFAR initiative [President’s Emergency Plan for AIDS Relief]. It was a bold & important commitment, but it didn’t go far enough in opening up the door to generics and getting the costs down. And as president, I will do that

Taxpayers pay for drug R&D, not drug companies

We’ve got to make it clear to the drug companies that they do deserve to be part of the solution, because we all benefit from the life-saving remedies they come up with, but we pay for it many times over. It is American taxpayers who pay for the research
& a lot of the clinical studies.

That’s why, while we’re looking at getting to universal health care, we also have to give Medicare the right to negotiate with drug companies to get the price down, to begin to rein in those costs across the board.

Need a health care system that manages chronic diseases

We need a universal health care system where we manage chronic diseases, where we get prices down because we can bargain with the drug companies, where we say to the health insurance companies that they must cover everyone, they have to do it at an
affordable rate. For people who might have some financial challenges, I am proposing health care tax credits that will make health care for everyone affordable. That that is the right way to go, because if we don’t have everybody in the system, we know
what will happen. The health care companies will continue to cherry pick. The hidden tax that comes when someone does finally show up at the emergency room will be passed onto everyone else. So I am adamantly in favor of universal health care.
We will have a system to make it affordable, but it will be required, as part of shared responsibility, under a new way of making sure that we don’t leave anybody out and provide quality, affordable health care for everyone.

Universal health care is a core Democratic principle

If you don’t start out trying to get universal health care, we know--and our members of Congress know--you’ll never get there. If a Democrat doesn’t stand for universal health care that includes every single American, you can see the consequences of what
that will mean. It is imperative that we have plans, as both John and I do, that from the very beginning say, “You know what? Everybody has got to be covered.” There’s only three ways of doing it. You can have a single-payer system, you can require
employers, or you can have individual responsibility. My plan combines employers and individual responsibility, while maintaining Medicare and Medicaid. The whole idea of universal health care is such a core
Democratic principle that I am willing to go to the mat for it. I’ve been there before. I will be there again. I am not giving in; I am not giving up; and I’m not going to start out leaving 15 million Americans out of health care.

Pledges to support $50B for AIDS relief in US and world

Today is World AIDS Day. All of us have committed to supporting $50 billion for global AIDS relief, which I am very excited about. But let’s not forget that AIDS now is growing again in our own country, particularly among African American and
Latino women. The leading cause of death for African American women between the ages of 25 and 34 is AIDS. So I want to ask all of my fellow candidates here if they would join me, not only in a pledge for what we’re going to do globally to address the
AIDS pandemic in Africa and Asia and elsewhere, but will you join me in a pledge that we’re going to do everything we can once again to address the AIDS pandemic right here in the US, and to put the money in that will provide the services and the
treatment and the prevention that our own people deserve to have. Because frankly we have turned our backs, we have frozen the amount of money, and I am very worried about what is happening to countless numbers of Americans when it comes to HIV and AIDS.

Worked on education & welfare in Arkansas but not healthcare

Health care was not a logical choice for Hillary--the way education or welfare policy would have been. She had served as chairman of the Children's Defense Fund, a national advocacy group, and in Arkansas had run a commission to improve the public school
system.

But Hillary wanted to lead national health-care reform. It would be the "signature initiative" of the 1st term, restructuring the entire health-insurance system and extending coverage to the 37 million uninsured. It would allow Hillary to
control the fate of $800 billion in annual spending--1/7 of the economy. What's more, Bill made the extravagant promise that he would introduce comprehensive health-care legislation within the 1st 100 days of his presidency. The Clintons were swinging
for the fences, attempting to secure a place in the history books with a sweeping policy that would rival anything Roosevelt had done. Their stunning ambition was matched only by the naivet‚ and impracticality of their expectations and strategies.

No parent should be told ‘no’ for healthcare for their kids

Q: As first lady, your attempt to establish universal health insurance failed. What did you learn so you can be successful the next time?

A: Well, I am very proud that we tried to provide universal health care to every American back in 1993 and 1994.
I learned a lot from that, and I’m going to be presenting a plan next week that will be universal. It will cover everyone, and it will make it clear that we as a rich nation with the values that should be the best in the world will once
& for all make it absolutely positive that everyone will have health care. Now it’s not only about the 47 million uninsured. Millions of insured Americans don’t get the health care they paid for. We have
a lot of people who, all of a sudden, their child needs an operation and the insurance company won’t pay for it. Well, we’re going to make it clear that there will be no parent who ever is told no when it comes to getting health care for their children.

Local smoking bans ok, but no national ban

Q: Over 400,000 Americans have premature death due to smoking or secondhand smoke. Would you be in favor of a national law to ban smoking in all public places?

A: Well, we banned it in New York City. And people thought it would be a terrible idea,
and everyone was really upset about it. And actually business at a lot of establishments, like restaurants and other places, increased, because many people felt more comfortable going when there was no smoking.
I think that we should be moving toward a bill that I have supported to regulate tobacco through the FDA. And once it has those health warnings and once the FDA can regulate it, I think that will give a lot of support to local communities to make these,
what are essentially zoning decisions. And I’d fully support that.

Q: But you’re not in favor of a national law to ban smoking in public places?

A: Not at this point. I think we’re making progress at the local level.

Outcry if AIDS were leading disease of young whites

Q: African-Americans, though 17% of all American teenagers, are 69% of the population of teenagers diagnosed with HIV/AIDS. What is the plan to stop and to protect these young people from this scourge?

A: Let me just put this in perspective. If
HIV/AIDS were the leading cause of death of white women between the ages of 25 and 34, there would be an outraged outcry in this country.

I’m working to get Medicaid to cover treatment. I’m working to raise the budget for Ryan White, which the Bush
administration has kept flat, disgracefully so, because there are a lot of women, particularly, who are becoming infected in poor rural areas as well as underserved urban areas in states where, frankly, their state governments won’t give them medical
care.

So this is a multiple dimension problem. But if we don’t begin to take it seriously and address it the way we did back in the ‘90s, when it was primarily a gay men’s disease, we will never get the services and the public education that we need.

Electronic medical records save $120 billion in health care

I have put forth approximately $120 billion in savings from health care changes--everything from electronic medical records to better management of chronic care. That is about in the ballpark of what all of us believe it will cost to cover everyone.
The challenge that I’m wrestling with is how do we realize the savings? I don’t think there is any Democrat that is not going to let the Bush tax cuts on the wealthiest Americans expire. We’re all going to do that, so that money will be available.

Source: 2007 Dem. debate at Saint Anselm College
, Jun 3, 2007

Insurers must fund prevention without preexisting conditions

Q: You said that we’re going to change the way we finance the system by taking money away from people who are doing well now. Who specifically are you talking about?

A: Well, let’s start with the insurance companies. The insurance companies make money
by spending a lot of money and employing a lot of people to try to avoid insuring you, and then, if you’re insured, to try to avoid paying for the health care you received.. My office spends a lot of effort helping people who have insurance get health
care. The insurance companies don’t want to pay for preventative health care because that’s like a lost amount of money because they’re not sure that the patient or the insured person will still be with them. That is upside down and backwards. So we
could save money if we changed the incentive to require that preventative health care and wellness be covered and incentivized, and we could require that every insurance company had to insure everybody and no exclusions for preexisting conditions.

Require electronic medical record for all federal healthcare

I want to start requiring that people who do business with the government, namely Medicare, Medicaid, VA, you name it, they’re going to have to move toward electronic medical records. And I’m willing to put some up front money into that to create a
system where all these different health care IT systems can talk to each other, [so no matter where you are], you start with a history.

After Hurricane Katrina I went down to Houston to see the people who had been evacuated, most in them from the
convention center. The elderly, the frail. People who were very dependent upon health care, their records were gone. Those 15 pieces of paper were destroyed. And a lot of doctors told me their biggest problem was trying to figure out what prescriptions
to give to people. The only people they could help were the people who had shopped at chain drug stores because they had electronic medical records. If we had that for all of our health records, we’d get costs down & we’d have higher quality health care.

Increase America’s commitment against Global AIDS

Sen. Clinton continues to work to increase access to health care. She authored legislation that has been enacted to improve recruitment and retention of nurses, to improve quality and lower the cost of prescription drugs, and to protect our food supply
from bioterrorism. She sponsored legislation to increase America’s commitment against Global AIDS, and is now leading the fight for expanded use of information technology in the health care system to decrease administrative costs & reduce medical errors.

Source: PAC website, www.hillpac.com, “Biography”
, Nov 17, 2006

FDA should compare drug effectiveness--not just safety

In 2003, President Bush and Congress upset their conservative base by creating the largest new entitlement program since the Johnson presidency.

Hillary opposed the bill, on the grounds it was not comprehensive enough. She supported numerous amendments
that would have enlarged the program and further increased government involvement in the dispensation of prescription drugs.

One of her amendments sought to order the National Institutes of
Health to conduct and compile more drug studies, as well as to advise and inform patients and doctors about which drugs work best. The amendment was specifically aimed at increasing the government’s role in medicine. Clinton defended it by noting, “While
the FDA is responsible for determining safety and effectiveness of prescription drugs compared to a placebo, there is no government entity responsible for examining whether drug A is more effective at treating a particular condition than drug B.”

Supply more medical needs of families, & insure all children

We have family responsibilities on both ends of the age spectrum. We need to expand the Family and Medical Leave Act. It doesn’t cover enough people. We need paid parental leave so that people can afford to have time off.
We need to ensure that every single child in America has health care, and these are the kinds of issues that Moms Rising is promoting.

Source: Annual 2006 Take Back America Conference
, Jun 14, 2006

Healthcare system plagued with underuse, overuse, and abuse

Hillary is the one person running for president with an enormous piece of unfinished business that requires her to succeed in the area where she has suffered her biggest defeat. She even has a sense of humor about it. Here is Hillary on
Health Care:

I know what you're thinking. Hillary Clinton and health care? Been there, Didn't do that!
The failure of the government to help contain health costs for employers has led to a fraying of the implicit social contract in which a good job came with affordable coverage.
As a whole, our ailing health care system is plagued with underuse, overuse and misuse. In a fundamental way, we pay far more for less than citizens in other advanced economies get.

Fought for pediatric rule: new drugs tested for child safety

Sometimes Hillary does come through in an important way. Republican Sen. Mike DeWine (R-OH) recounts how she battled successfully alongside him for the “pediatric rule” requiring drug companies to use scientific testing to determine if their medications
are safe for children and at what doss they should be administered. “When she was First Lady, Hillary pressured the FDA to approve the rule,” DeWine said. “But the courts threw it out saying Congress had to authorize the FDA to issue the rule first. So
when she got to the Senate, she worked hard with Democratic senators and me to pass a bill doing just that.“ DeWine, a card-carrying Republican, credits Hillary with ”holding the left in check“ so that they would not load the bill with requirements as it
passed the Senate, which would have doomed it in the more partisan and conservative House of Representatives.”

But her proposals reflect a minimalist bite-size strategy--her proposals have been very limited, mostly just nibbling around the edges.

Low-tech low-cost water treatment for developing world

Bangladesh, the most densely populated country on earth, presented the starkest contrast of wealth and poverty I saw in South Asia. But this was another country I had long wanted to visit, because it was home to two international recognized projects--the
International Center for Diarrheal Disease Research (ICDDR/B) in Dhaka, Bangladesh, and the Grameen Bank, a pioneer of microcredit. The ICDDR/B is an important example of the positive results that come from foreign aid. Dysentery is a leading cause of
death, particularly among children, in parts of the world where there are limited sources of clean drinking water, The ICDDR/B developed "oral rehydration therapy" (ORT), a solution composed mostly of salt, sugar and water, that is easy to administer
and responsible for saving the lives of millions of children. This simple, inexpensive solution has been called one of the most important medical advances of the century, and the hospital that pioneered it depends on American aid.

Millions uninsured is source of America's healthcare crisis

By the time Bill became President, 37 million Americans, most of them working people & their children, were uninsured. They weren't getting access to care until they were in a medical crisis. Some went broke trying to pay for medical emergencies on their
own.

Rising health care costs were sapping the nation's economy, undermining American competitiveness, eroding workers' wages, increasing personal bankruptcies & inflating the national budget deficit. As a nation, we were spending more on health care--
14% of our GDP--that any other industrialized country.

This terrible cycle of escalating costs and declining coverage was largely the result of a growing number of uninsured Americans. Patients without insurance seldom could afford to pay for their
medical expenses out-of-pocket, so their costs were absorbed by the doctors and hospitals that treated them. Doctors and hospitals, in turn, raised their rates to cover the expense of caring for patients who weren't covered or couldn't pay.

Recommended "managed competition"; not single-payer system

[On the 1994 healthcare taskforce], some proposed a "single payer" approach, modeled on the European and Canadian health care systems. The federal government, through tax payments, would become the sole financier--or single payer--of most medical care.
A few favored a gradual expansion of Medicare what would eventually cover all uninsured Americans, starting first with those aged 55 to 65.

Bill and other Democrats rejected the single-payer and Medicare models, preferring a quasi-private system
called "managed competition" that relied on private market forces to drive down costs through competition. The government would have a smaller role, including setting standards for benefit packages and helping to organize purchasing cooperatives.
The cooperatives were groups of individuals and businesses forget for the purpose of purchasing insurance. Together, they could bargain with insurance companies for better benefits and prices and use their leverage to assure high-quality care.

Fund teaching hospitals federally because market fails

Q: In 1993, why did you recommend measures that would have hurt New York’s teaching hospitals?

CLINTON: Senator Moynihan was absolutely right to propose a piece of legislation that would guarantee that our teaching hospitals will be funded to
perform the functions that they do which can not be performed within the market at a profit, namely, training our doctors and nurses and providing health care for the sickest of the sick and doing the research we all benefit from.

LAZIO: You know, a
New Yorker would never have made that proposal. Mrs. Clinton has had two opportunities - two opportunities to make policy: One on health care and one on education. And on health care it was an unmitigated disaster. It would have led to health
care rationing. It would have destroyed teaching hospitals. It would have led to all types of unintended consequences, perhaps. But the bottom line is it would have been terrible for New York.

Regulate tobacco; fine of $3000 for every underage smoker

By regulating tobacco products, we can make sure that the tobacco industry is not allowed to target our kids with their deadly products. If elected, I would work on legislation to regulate tobacco. I would also
assess the Tobacco Industry $3,000 for every underage smoker if youth smoking is not lowered by 50% by 2004.

Source: Remarks at New York City Annual Kick Butts Day
, Apr 5, 2000

Be prepared with defenses against infectious disease

We need to be as well prepared to defend ourselves against public health dangers as we should be to defend ourselves against any foreign danger. The Republicans are sending a message that we don’t need to be prepared.
for early detection of infectious outbreaks like encephalitis or the West Nile-like virus.

Source: Remarks at Fordham University, Armonk
, Oct 14, 1999

Medicare should be strengthened today

We must extent Medicare’s life by an additional decade and offer a prescription drug plan. We have the means to do it today.

Source: Remarks in Great Neck, Long Island
, Sep 14, 1999

GOP overwhelmed by her health reform knowledge

Where some Republicans were overwhelmed by Hillary Rodham Clinton's detailed knowledge of the work of her secret health care task force, Newt Gingrich had been studying the issue longer. He told me in the spring of 1984 about a meeting with the First
Lady, a session that any reporter would like to have witnessed.

"We had a good discussion," said the Speaker-to-be. "I begged her not to go for the whole reform package that puts at risk 1/7 of the American economy.
My advice was to go for four small reforms to see what worked. Try ensuring portability of health insurance when people change jobs. See that preexisting conditions are covered. Take care of malpractice and tort reform. Create medical savings accounts.
That sort of thing. If she tried to do it all, she would fail."

And fail she did, in dramatic fashion a few months later, just before the historic elections to come.

$100B to get started on healthcare reform

Hillary was immersing herself in health care and spending a good deal of time briefing members of Congress on Capitol Hill. Prior to one gathering with 50 senators from both parties later in the month, two of her staff members noted that the senators
were likely to ask about costs. "I don't care how they do things here," Hillary said defiantly. "If they can't take the truth, at least they're going to get it from me."

In the meeting when the question of cost arose, Hillary casually tossed out the
$100 billion figure. Senator Jay Rockefeller, a close administration ally on health care reform, dropped his jaw. If they were planning to spend $100 billion, a large new unpopular tax would be unavoidable. After the meeting, Rockefeller had to be sent
out to clean up the damage.

One of Hillary's staffers took her aside and expressed concern about using the $100 billion number. "That's the truth, and they'd better get used to it," Hillary replied.

Smaller steps to progress on health care

In 1993, Hillary chaired the Task Force on National Health Care Reform. After months of meeting with families & health care professionals, the Task Force recommended the Health Care Security Act of 1994. “I am
disappointed we were not able to make more progress.” Hillary said. “Now I’m from the school of smaller steps, but I believe we must continue to make progress. It’s still important that we increase access to quality health care for working families.”

Source: www.hillary2000.org “About Hillary”
, Jan 1, 2000

Hillary Clinton on 1990s HillaryCare

Hillary appointed 8 days after inauguration to health cmte

Eight days after the inauguration, Bill appointed Hillary head of the health-care task force, which was charged with developing a plan to re-structure the health-insurance system. The move took nearly all his top officials by surprise, including Al Gore.
Bill had invested Gore with considerable responsibility, but his failure to confide in his vice president was a telling sign of the real pecking order.

Bill and Hillary’s joint decision-making at the beginning of his presidency was as overt as it
would ever be in the White House. “He would say, ‘Hillary thinks this. What do you think?’” said one insider. “They really were a partnership. She was the absolutely necessary person to bounce things up against. I sensed a tremendous need for each other.

Gore was the one most affected by Bill’s reliance on his wife. It was a given in the White House that everyone would ”just have to get used to“ the fact that Hillary, along with Bill and Gore, had to ”sign off on big decisions.“

A plan is necessary; but consensus is more necessary

Q: You have been involved with health care for a long time. Because of your long involvement, you should have been first out of the gate on health care.

A: Well, I’ve been at the gate and out of it for 14 years, and you know when we weren’t successful
with the overall reform, I moved ahead and was one of the people responsible for the children’s health-insurance program and trying to make sure drugs were safe for kids, and dealing with aftereffects the Gulf War veterans suffered.
So, I’ve stayed consistently focused on health care and am engaged right now in this battle with the president over his threatened veto of the children’s health-insurance program. But I learned, among other things, that we’ve got to build a consensus.
A plan is necessary but not sufficient. We’ve got to have a political consensus in order to withstand the enormous opposition from those interests that will have something to lose in a really reformed health-care system.

1993:Ambitious role plagued from start by secrecy complaints

Five days after reciting the oath of office, Bill announced the formation of the President’s Task Force on National Health Care Reform, to be chaired by the First Lady.

Bill and Hillary set two ambitious goals--rewriting the complex rules that governed
14% of the economy & meeting the deadline of delivering a proposal to Congress within 100 days.

The country seemed comfortable with the historic decision to put a First Lady in charge of a major policy challenge.
It didn’t take long for the honeymoon to end. The Washington Times, in an article entitled “First Lady’s Task Force Broke Law on Secrecy,” claimed that reporters had been barred from the
first meeting of the task force--an apparent violation of a law because Hillary was not a federal employee and the law allows outsiders to be kept out of advisory committee meetings only if all participants are federal employees.

1990s plan failed after big pharma & insurance worked on it

I do have the experience of having put forth a plan, with many of the features that [my opponents have] mentioned. And people were enthusiastic about it initially, but then after the insurance companies and the pharmaceutical companies got finished
working on it, everybody got nervous and so politically we were not successful. Well, I’m ready to try again, and there’s three things we’ve got to do. We’ve got to control and decrease costs for everyone. This is not just about the uninsured.
Yes, we have nearly 47 million uninsured, but we’ve got many millions more who have an insurance policy that they can barely afford and that they can’t get the treatments they need under it. We have to cover everybody but we’ve got to improve quality.
We can save money within the existing system. I am not ready to put new money into a system that doesn’t work until we’ve tried to figure out how to get the best outcomes from the money we already have.

1990s healthcare reforms laid groundwork for today’s reforms

I feel a little bit like this is deja vu all over again. All those years ago, we tried to convince the country and the Congress--we convinced the country but we didn’t convince the Congress!--that we needed to move toward and achieve universal health
care coverage. Now, I am proud we tried. We may not have succeeded, but we set the groundwork in place so that now people are saying, boy, we wish we had done that back then because costs have continued to increase. Pressures on the system, on our
doctors, our nurses, our health care workers have just been so stressful. So what we need to do is to make a commitment. And I’m proud that everyone running on the Democratic side is committed to universal health care coverage. I am in favor of universal
health care coverage that brings in the 47 million who are uninsured--which is a disgrace--and begins to guarantee coverage to people who already have insurance, because there are a lot of people who think they have insurance except when they need it.

Still scarred from 1990s reform, but now doing it better

You know, I have a little bit of experience in trying to reform health care. And I still have the scars to show for it. I needed some health care after that was over.
And I am absolutely convinced this time we’re going to do it because the people that come to talk to me now they’re CEOs of companies, they’re doctors and nurses and hospital administrators.
They know that if we don’t change the system we have, it’s going to continue hemorrhage money. We’re going to have more uninsured people. We’re going to have the fastest growing problem of people who are not going to get what they thought
they paid for, and we’re going to continue to lose jobs. They’re going to be sent to other countries because we’re not being able to provide health care at a decent cost.

1997: Helped found State Children’s Health Insurance Program

As First Lady, I worked with members of Congress in creating the State Children’s Health Insurance Program (SCHIP) in the summer of 1997. It made a tremendous investment in the expansion of children’s health insurance, and it has had tremendous results.
Today, because of SCHIP the number of children who lack health insurance coverage has dropped from over 10 million in 1995 to some 8.3 million kids in 2005. However, the number of uninsured have grown in the general population over the last 10 years.

More people read my health plan abroad than in the US

In 2005, Hillary received an honorary degree from a Canadian women's university. It cited her work and leadership on health care reform. The Canadian citizens and doctors she met praised her, and said what she was trying to do was absolutely right. It
was so discouraging for her to see the Canadians understood she had been right, while it seemed nobody in the US thought so.

The previous month Hillary had been in the Ukraine touring a hospital, and the minister of health had taken out a copy of her
Health Security Act and asked her to autograph it. The plan was brilliant, the minister said, and he hoped she knew how useful it was in guiding the Ukrainians as they attempted to figure out how to rebuild their health care system.

Hillary burst out
laughing but the bitterness was evident: "I travel around the world, and this happened to me dozens of times now, somebody from another country tells me that they be read it and analyzed it. More people have read it in the Ukraine than read it in the US.

1993 health plan initially praised as moderate & workable

[Under the Clinton health plan], everyone would have coverage, through private insurers, that would not be lost when there was an illness or a job change; there would be far less paperwork because of a uniform minimum-benefit package; we would reap
large savings through lower administrative costs.

I proposed that all employers provide health insurance, as 75% of them were already doing, with a discount for small-business owners who otherwise couldn't afford the insurance.
The subsidy would be paid for by an increase in cigarette taxes.

Hillary, and all those who helped, had crafted a plan that we could implement while reducing the deficit. And contrary to how it was later portrayed, health experts generally
praised it at the time as moderate and workable. It certainly wasn't a government takeover of the health-care system, as its critics charged, but that story came later.

1990s reform called “secretive” but had 600 in working group

In the absence of a crisis like a depression, passing a health care plan was going to be difficult. We wanted a plan that dealt with all aspects of the health care system.

In addition to the President’s Task Force, we organized a giant working group of
experts that would consider every aspect of health care. This group, comprising as many as 600 people, met regularly to debate and review specific parts of the plan in detail.

On February 24, we were dealt a blow that none anticipated.
Groups affiliated with the health care industry sued the task force over its composition, claiming that because I was not a government employee, I was not allowed to chair or attend closed task force meetings.

It was a deft political move, designed to
disrupt our work and foster an impression with the public and the media that we were conducting secret meetings.

We were trying to move too quickly on a bill that would fundamentally alter social and economic policy for years to come.

When last Republican backed out, HillaryCare died

[In July 1994], we continued to try to work for a compromise with Republicans in Congress on various aspects of reform. I admired Sen. John Chafee (R, RI) for his principled stands and decent manner; he had been an early supporter of reform and an
advocate for universal coverage. Sen. Chafee had worked with his Republican colleagues to develop his own thoughtful proposal and hoped that, by melding his plan with ours, he would garner enough bipartisan support to pass a bill.
Chafee made heroic efforts to bridge the gap between Republicans and Democrats, keeping up his effort until he was the lone Republican still fighting for reform. Finally, he, too, abandoned his cause. Without a single Republican supporter, health care
reform was like a patient on life support being given last rites.

Health care faded with barley a whimper. I still think that was the wrong call. Giving up without one last public fight demoralized Democrats and let the opposition rewrite history.

Despite failure, glad she tried system-wide reform

Bill and I were disappointed and discouraged [by reform failure]. I knew I had contributed to our failure, both because of my own missteps and because I underestimated the resistance I would meet as a First Lady with a political mission. But our most
critical mistake was trying to do too much, too fast.

That said, I still believe we were right to try. Our work in 1993 and 1994 paved the way for what several economists dubbed the "Hillary Factor," the purposeful restraint on price increases during
the 1990s. It also helped to create the ideas and political will that led to important smaller reforms in the years following.

On balance I think we made the right decision to try to reform the whole system. Someday we will fix the system.
When we do it, it will be the result of more than fifty years of efforts by Harry Truman, Richard Nixon, Jimmy Carter and Bill and me. Yes, I'm still glad we tried.

1994 "Harry & Louise" ads exploited consumer fears

The Health Insurance Association of America launched a round of advertisements, featuring a couple named Harry and Louise. Sitting at a kitchen table, Harry and Louise asked each other cleverly contrived questions about the plan and wondered aloud what
it might cost them. As intended, the ads explained the fears--pinpointed by focus groups--of the 85 percent of Americans who already had health insurance and worried it might be taken away.

For the Gridiron Dinner, Bill and I decided to stage a
parody of the insurance lobby's TV spot, with Bill playing "Harry" and me playing "Louise." It would give us a chance to expose the scare tactics employed by our opponents and have some fun:

Me: On page 3,764 that under the
Clinton health security plan, we could get sick.

Bill: That's terrible.

Announcer: "Paid for by the Coalition to Scare Your Pants Off."

Our videotaped performance was widely covered, even replayed on several Sunday morning new shows.

1990s plan based on employer mandate

The health insurance fiasco involved two related failures: a substantive failure and a political one. The substantive failure had to do with the plan that emerged from the Health Care Task Force led by Mrs. Clinton and Ira Magaziner: It was intended as
the simplest, most direct path to universal coverage, a mere extension of the messy American status quo--all employers would be required to provide health insurance for their employees. This "employer mandate" aroused intense opposition from the
small-business community and it Republican friends in Congress, of course. But it was also an odd position for Bill Clinton to be taking, more of an Old than a New Democrat solution. The plan was cluttered with ancillary details: In order to "prove" that
the new system would not bust the budget, a ridiculously detailed proposal was written, which specified the sort of coverage employers would have to provide & also created a complicated bureaucracy to make sure that health care costs remained in control.

Learned lessons on health care; but hasn’t given up goal

You may remember I had a few ideas about health care. I’ve learned a few lessons since then. But I haven’t given up on the goal. That’s why we kept working step by step to insure millions more kids through the Children’s Health
Insurance Program. And that’s why it’s time to pass a real Patients’ Bill of Rights and provide access to affordable health care for every single child and family in this country.

Source: Address to the Democratic National Convention
, Aug 14, 2000

1979: Developed program to deliver rural healthcare

In 1979, Bill Clinton named Hillary Rodham to head a state board. As chair of the forty four member state Rural Health Advisory Committee, she helped develop a program to deliver adequate health care to people in small, isolated communities.
The appointment was made without fanfare, and there were no public condemnations by partisan opponents.

Source: The Inside Story, by Judith Warner, p.102
, Aug 1, 1999

1994: can't fix just part of problem; it's all or nothing

I was always puzzled by Hillary's mistakes in the health-care debate of 1993-4. She became fascinated by the idea of a complete reworking of the health-care system & fashioned a white elephant that wouldn't sell and undermined the president's credibility

In early September 1994, it became clear that the president didn't have the votes even to get the health-care bill out of Senate committee. I warned Hillary that the failure to pass any health reform at all would seriously injure the administration in
general and her reputation in particular. I suggested that she back a limited bill to ensure that workers could take health insurance with them when they changed jobs and that pre-existing conditions.

Hillary was adamant that she would not back such
a bill, because "you can't fix part of the problem,. If you do this over here, it causes this bad reaction over there. You've got to do it all or do nothing." She also worried that the legislation I was suggesting might lead to higher premiums.

Hillary Clinton on 2008 HillaryCare

2006: If I can't do universal coverage, why run?

In Sep. 2007 came the unveiling of her signature domestic issue, health care. Back in December, she told an adviser, "If I can't do universal coverage, what's the point of running?" That was far from a casual remark. Her failure to enact universal health
care during [in 1993] had helped Republicans seize control of Congress, a devastating defeat for the Democrats and personally a bitter one for her. Now she made it known that if elected she intended to push aggressively for universal coverage.

Her new
plan was carefully crafted and politically astute, offering detail where necessary and avoiding it where possible. Clearly, she had learned her lesson from the health care debacle. Since most people who have insurance want to keep what they have, she
built her plan on the existing system of employer-based insurance, with alternatives for those who did not have insurance through their work. Her plan, unlike Obama's, imposed a mandate, requiring that everyone purchase some kind of insurance.

AdWatch: Got health insurance for six million kids

Clinton campaign ad, “Obligation”:Narrator: She fought for universal health care long before it was popular. Got health insurance for six million kids, and expanded access to health care to the National Guard. Now she’s the only candidate for
president with a plan to provide health care for every American. A top economist calls Hillary’s plan the difference between achieving universal health coverage--and falling far short. If you believe health care is America’s moral obligation, join her.

Include everyone, to avoid cherry-picking and its hidden tax

CLINTON: Sen. Obama’s plan does not cover everyone. It would leave, give or take, 15 million people out.

OBAMA: Sen. Clinton suggests that I want to leave 15 million people out. I dispute it, and I think it is inaccurate. The reason she thinks that
there are more people covered under her plan than mine is because of a mandate.

CLINTON: The difference between Sen. Obama and myself is that I know, from the work I’ve done on health care for many years, that if everyone’s not in the system we will
continue to let the insurance companies do what’s called cherry picking--pick those who get insurance and leave others out. We will continue to have a hidden tax, so that when someone goes to the emergency room without insurance--
15 million or however many--that amount of money that will be used to take care of that person will be then spread among all the rest of us. In my plan there is enough money to provide the kind of subsidies so that everyone would be able to afford it.

Healthcare without mandate is like voluntary Social Security

CLINTON: I know that parents who get sick have terrible consequences for their children. So you can insure the children, and then you’ve got the bread-winner who can’t afford health insurance or doesn’t have it for him or herself. And in fact, it would b
as though Franklin Roosevelt said let’s make Social Security voluntary--let’s let everybody get in it if they can afford it--or if Pres. Johnson said let’s make Medicare voluntary. What we have said is that at the point of employment, at the point of
contact with various government agencies, we would have people signed up. It’s like when you get a 401(k), it’s your employer. The employer automatically enrolls you. Now, if you want to say that we shouldn’t try to get everyone into health insurance,
that’s a big difference, because I believe if we don’t have universal health care, we will never provide prevention.

OBAMA: I believe that if we make it affordable, people will purchase it. In fact, Medicare Part B is not mandated, it is voluntary.

Many uninsured are young & don’t think they need coverage

CLINTON: About 20% of the people who are uninsured have the means to buy insurance. They’re often young people who think they’re immortal.

OBAMA: Which is why I cover them.

CLINTON: Except when the illness or the accident strikes. And what Sen.
Obama has said, that then, once you get to the hospital, you’ll be forced to buy insurance, I don’t think that’s a good idea. We ought to plan for it, and we ought to make sure we cover everyone. That is the only way to get to universal health care
coverage. But if we don’t even have a plan to get there, and we start out by leaving people, you’ll never ever control costs, improve quality, and cover everyone.

OBAMA:
With respect to the young people, my plan specifically says that up until the age of 25 you will be able to be covered under your parents’ insurance plan, so that cohort that Sen. Clinton is talking about will, in fact, have coverage.

Make it illegal to discriminate against sick people

You know, 350,000 children in Texas get health care every month because I helped to start the Children’s Health Insurance Program. And 21,000 National Guard and Reserve members get access to health care because
I went across the party line and joined up with a Republican senator to make that happen. So there’s a lot that we’ve already done. But there’s so much more to do.

I want to take on the tough issues that face us now.
I want to stop the health insurance companies from discriminating against people because they’re sick. You know, it’s unconstitutional to discriminate on the basis of race or gender or ethnic origin or religion, but it’s
OK to discriminate against sick people. And we’re going to end that, because it’s time we said no more.

Tired of health insurance companies deciding who live or die

When I took on universal health care back in ‘93 and ‘94, it was against a firestorm of special interest opposition. I was more than happy to do that, because I believe passionately in getting
quality affordable health care to every American. I don’t want to leave anybody out. I see the results of leaving people out. I am tired of health insurance companies deciding who will live or die.

Universal health care will not work if it is voluntary

Obama has a mandate for parents to be sure to ensure their children. I agree with that. If we don’t go and require everyone to have health insurance, the health insurance industry will still game the system. Everyone of us with insurance will pay the
hidden tax of approximately $900 a year to make up for the lack of insurance. Edwards made a great point. It would be as though Social Security were voluntary. Medicare, one of the great accomplishments of President Johnson, was voluntary.
I do not believe that is going to work. You look at what will work and what will not work. If you do not have a plan that starts out attempting to achieve universal health care, you will be nibbled to death, and we will be back here with more
and more people uninsured and rising costs. Obama recognizes that unless we have some kind of restriction, we will not get there. He’s also said that if people show up at a hospital sick, without health insurance, maybe at that point you can fine them.

Mandate insurance AND make it affordable for all

OBAMA: [to Clinton]: About 95% of our plans are similar. But I emphasize reducing costs. Sen. Clinton believes that we have to force people who don’t have health insurance to buy it. But if you are going to mandate the purchase of insurance & it’s not
affordable, then there’s going to have to be some enforcement mechanism that the government uses. And that, I don’t think, is helping those without health insurance.

CLINTON: Contrary to that description, we actually will make it affordable for
everyone, because my plan lowers costs aggressively; and improves quality for everyone. And the way it covers all of those who wish to participate is that it will provide subsidies, and it will also cap premiums, because we want to make sure that it is
affordable for all. So, when you draw the distinction that, “Well, it’s not affordable, therefore people will have to be made to get it,” well, the fact is, it has been designed to be affordable with health care tax credits.

Health care tax credit ensures affordability

I helped to create the children’s health insurance program back in 1997. I am totally committed to making sure every single child is covered. I provide a health care tax credit under my American Health Choices
Plan so that every American will be able to afford the health care. I open up the congressional plan, but there is a big difference between Obama and me. He starts from the premise of not reaching universal health care.

Source: 2007 Democratic debate in Las Vegas, Nevada
, Nov 15, 2007

Insurance companies cannot deny people coverage

My proposal gives the insurance companies an ultimatum. They have to get into the business of actually providing insurance, instead of trying to avoid covering people. They cannot deny people coverage. They cannot have a pre-existing condition which is
not covered. That is one of the biggest problems that doctors face. They face this constant barrage of harassment and bureaucratization from the private insurance world. We need to clean up Medicare & Medicaid. They’re not as friendly as they need to be.

Source: 2007 Democratic debate at Drexel University
, Oct 30, 2007

Condemns insurers as motivated by greed

[In 1993, Hillary defended her health care plan] She bitterly condemned the greed of health insurers, who she said were pushing the United States “to the brink of bankruptcy.”

American Health Choices Plan: keep yours or pick Congress’

The American Health Choices Plan does not create any new bureaucracy. It is not government-run health care. If you are satisfied with your health care, you keep it, no questions asked.

But if you are one of those 47 million uninsured, or if you are
one of the many millions more who actually have insurance except when you really need it and the insurance company won’t pay for what your doctor has prescribed, you will now have the same choices that are available to members of Congress, because we
will open up the plan that members of Congress have and give you a health choices menu to choose from.

We will also provide a health care tax credit for those who cannot, on their own, afford it or who don’t have employer help. Similarly, I will
provide a new small business health care tax credit because a lot of small businesses tell me that they’d love to be able to help provide health care for their employees, but they just can’t afford it, and we’re going to make it affordable.

Pay for health plan by $52B tax repeal & $77B efficiencies

Q: Your new plan says you would insure the 47 million Americans who are uninsured. And let’s talk about how you would pay for it. You say that you’d get $52 billion from repealing the Bush tax cuts for the wealthy and $77 billion from making the system
more efficient. If you’re unable to get those savings from waste and fraud and abuse, would you raise taxes further or would you cut your program?

A: In our system, we have a lot of inefficiencies. Let’s take electronic medical records, because if we
were to have a system where everyone had a private, confidential health care record--this is something that I’ve worked on with Newt Gingrich--we would see that we would save a lot of money. If we better managed chronic care, we would save money, because
right now we don’t, and we pay a big price for it. My plan has about $52 billion in tax cuts, by moving the tax rates back to the pre-Bush era. And yes, taxes will go up on people making $250,000, but most Americans will see a net tax decrease.

Mandated responsibility by individuals, industry & employers

Q: You talk a lot about choice in your plan, but you still have sweeping government mandates.

You mandate that all Americans would have to buy insurance or face penalties, even young people who may not want it.

You mandate that large businesse
would have to insure employees or pay a tax.

And you mandate that insurance companies would have to offer coverage to all applicants no matter how sick they are.

So isn’t there still a good deal of government coercion in your plan?

A:
Well, there is certainly a shared responsibility that goes with having a health care system that both can afford to provide quality affordable health care for everyone and puts responsibility on everyone in our country. Individuals will have to have
insurance, but we’re going to make it affordable. The health care industry, the drug industry, are going to have to change the way they conduct business. Business will take responsibility, but within a system that will actually get their costs down.

Since 1993, new consensus developed on need for healthcare

Q: You introduced a bill in 1993 when you were first lady working with President Clinton, on this big issue of universal healthcare. It got nowhere. What’s different now?

A: I’m proud that we tried in ‘93.
Obviously, we made a lot of mistakes. [With my new plan], if you’re one of the 47 million Americans without health insurance, then you are going to have access to the same health choices menu that members of Congress do.
I proposed that back in ‘93, and ran into a firestorm of opposition from the Congress. But I think a lot has changed in the last 14 years. A consensus has developed about what we need to do to try to reach quality, affordable healthcare.
A consensus has developed because people who didn’t approve of what we were trying to do or who were on the sidelines have seen what has happened. It is not only a moral imperative that we try to cover everyone, it is now an economic necessity.

Include insurance industry in discussions, but rein them in

Q: Should the insurance industry be kept out of healthcare reform?

A: Well, I can’t say how you prevent people who have legitimate businesses in America from participating in the political process. It’s somewhat silly to suggest that talking to people
is somehow out of bounds. My coverage plan dramatically reins in the influence of the insurance companies, because frankly I think that they have worked to the detriment of our economy & our healthcare system.

Q: Because of your long history, do you
take contributions from insurance companies?

A: Well, I take from executives or people that work for them, just like I do from every part of the economy. What’s important here is, can you put together a strong enough political coalition to withstand
their understandable efforts? In American democracy, everybody gets to express an opinion, and some unfortunately have a disproportionate opinion, and that’s why it takes a lot of strength & experience to stand up to them. And I think I have proven that.

Universal health care coverage by the end of my second term

Q: Many experts project that it would cost between $90 billion and $120 billion to actually achieve universal health care for everyone in America. Is comprehensive reform achievable financially?

A: We already spend more money than anybody else in the
world, by about $800 billion, and we have 47 million uninsured. We’re also at a competitive disadvantage because other countries either provide health care or don’t, and our companies are trying to be competing in a global economy. So I want to figure
out how we provide universal health care without putting billions more into the system. Let’s get prescription drug prices down by negotiating with the drug companies, for example. I am going around the country, and I’m asking people’s advice, then
I’m going to be proposing a specific plan. You know, President Kennedy said in his inauguration that he wanted to have a man on the moon by the end of the decade. Well, I want to have universal health care coverage by the end of my second term.

I have the expertise to achieve universal healthcare for all

We are going to provide quality, affordable, universal healthcare coverage to every single American! I learned a lot about what we need to do to get it done. There’s a big difference between calling for it, impassioned
speeches about it, presenting legislation that embodies your hopes and dreams, and another thing to put together the political coalition to actually make it happen.

We need a uniquely American solution to health care

Q: What about health care?

CLINTON: We need a uniquely American solution to our health care challenges. [For example], I have pushed to have a big pool that small businesses could participate in, like we do in the federal government. Small businesses
should be able to join together like the Federal Employee Health Benefit Plan. There are pieces of things we should do now, but there’s no doubt that we need to have a national conversation-the payers, the employers, the doctors, the nurses, and those of
us in public life--we need to get this fixed, once and for all.

SPENCER: I believe in the concept of health savings accounts. That creates jobs instead of punishing corporations and providers of jobs. Cut the taxes, and let them set up health savings
accounts. With regards to the small business pools, small business owners say they are not getting help from Sen. Clinton to create associations so they can get the same rate as IBM and General Motors on health insurance. That’s what we need to do.

Hillary Clinton on ObamaCare

Non-employer system better; but don't turn back ObamaCare

Hillary Clinton showed more signs of flexibility on how Obamacare is implemented, but she insisted the law is too important to "turn the clock back." Clinton said, "I have said many times that if we were starting from scratch, we wouldn't have built
an employer-based system," But since that's the system we have, she said, it's important to make it work.

Clinton suggested she's open to different ways of achieving the health law's goals. She praised Arkansas for carrying out a new approach to
expanding Medicaid coverage, by using the federal money to buy private health insurance for more than 100,000 low-income residents.

But the main goal, Clinton said, should be to keep moving ahead with the law. And in a subtle swipe at the Obama
administration, she suggested that the law's supporters haven't done the best job explaining what Americans stand to gain from it. "We have to do a better job than has been done, quite frankly, in explaining the benefits," Clinton said.

2007: recast 1990s disaster as experience to make it happen

[In 2007] Hillary's mastery of the issues had been on full display--and Obama had been exposed for the naif she knew he was, coming across as vague and weak and windy. She had neutralized many of her most glaring vulnerabilities.
She had blurred the distinctions between her and Obama on Iraq, adroitly changing the subject from which candidate was most anti-war to who was more qualified to bring the conflict to an end.

She had recast her awful history with health care reform,
unveiling her long-awaited plan in mid-September and getting rave reviews for her substantive prowess, the detail and clarity of her presentation, and her self-deprecating allusions to her disastrous attempt to overhaul the system as First Lady.

She's watched as Obama's campaign was hammered for producing a proposal that was an obvious rip-off of hers. She'd begun to defuse her rival's message, where she said, "change is just a word without the strength and experience to make it happen."

We need a movement to get healthcare done this time

She said [at a primary debate], "We're supposed to limit this to three minutes. As some of you know, I can talk three hours or three days on health care." Though Clinton did not have a plan at that point, it was quickly apparent how expert she was at a
March 2007 debate. Health care was her passion, and it showed. It is a disgrace, she thundered, to have millions of Americans left out of the health care system. "We need a movement.
We need to make this the number one voting issue in the '08 election," she said as her words were drowned out by rising applause. "We're going to get it done this time." She was even more impressive during the questions.
When she finished, someone in the audience yelled out, "You go, girl!"

Hillary Clinton on Voting Record

Health care initiatives are her first priority in Senate

In her first address from the Senate floor, Hillary Clinton offered an agenda of health care initiatives, casting herself as a moderate on the very issue that resulted in one of her most embarrassing defeats as first lady. The Clinton administration’s
failed attempt to overhaul the nation’s health care system was widely derided at the time as big-government liberalism. She said that the experience [taught her] “the importance of bipartisan cooperation and the wisdom of taking small steps to get a big
job done,“ she said.

She called for expanding eligibility for the government-run Children’s Health Insurance Program. Her plan, she said, would enable roughly five million more children to enroll. Clinton also proposed financial bonuses as a reward to
states that aggressively enroll more children in the program. And she called for establishing a new national health insurance program for low-income families that is modeled after a NY program. She offered no details in her speech.

I support the primary objective of this legislation, to forestall reductions in physician payments. Yet taking choices away from seniors to pay physicians is wrong. This bill is objectionable, and I am vetoing it because:

It would harm beneficiaries by taking private health plan options away from them.

It would undermine the Medicare prescription drug program.

It is fiscally irresponsible, and it would imperil the long-term fiscal soundness of Medicare by using short-term budget gimmicks that do not solve the problem.

In addition, H.R. 6331 would delay important reforms like the Durable Medical
Equipment, Prosthetics, Orthotics, and Supplies competitive bidding program. Changing policy in mid-stream is also confusing to beneficiaries who are receiving services from quality suppliers at lower prices. In order to slow the growth in Medicare spending, competition within the program should be expanded, not diminished.

Proponent's argument to vote Yes: Sen. PATTY MURRAY (D, WA): President Bush vetoed a bill that would make vital improvements to the program that has helped ensure that millions of seniors and the disabled can get the care they need. This bill puts an emphasis on preventive care that will help our seniors stay healthy, and it will help to keep costs down by enabling those patients to get care before they get seriously ill. This bill will improve coverage for low-income seniors who need expert help to afford basic care. It will help make sure our seniors get mental health care.

Voted NO on means-testing to determine Medicare Part D premium.

CONGRESSIONAL SUMMARY: To require wealthy Medicare beneficiaries to pay a greater share of their Medicare Part D premiums.

SUPPORTER'S ARGUMENT FOR VOTING YES: Sen. ENSIGN: This amendment is to means test Medicare Part D the same way we means test Medicare Part B. An individual senior making over $82,000 a year, or a senior couple making over $164,000, would be expected to pay a little over $10 a month extra. That is all we are doing. This amendment saves a couple billion dollars over the next 5 years. It is very reasonable. There is nothing else in this budget that does anything on entitlement reform, and we all know entitlements are heading for a train wreck in this country. We ought to at least do this little bit for our children for deficit reduction.

OPPONENT'S ARGUMENT FOR VOTING NO: Sen. BAUCUS: The problem with this amendment is exactly what the sponsor said: It is exactly like Part B. Medicare Part B is a premium that is paid with respect to doctors' examinations and Medicare reimbursement. Part D is the drug benefit. Part D premiums vary significantly nationwide according to geography and according to the plans offered. It is nothing like Part B.

Second, any change in Part D is required to be in any Medicare bill if it comes up. We may want to make other Medicare changes. We don't want to be restricted to means testing.

Third, this should be considered broad health care reform, at least Medicare reform, and not be isolated in this case. LEGISLATIVE OUTCOME:Amendment rejected, 42-56

Voted YES on requiring negotiated Rx prices for Medicare part D.

Would require negotiating with pharmaceutical manufacturers the prices that may be charged to prescription drug plan sponsors for covered Medicare part D drugs.

Proponents support voting YES because:

This legislation is an overdue step to improve part D drug benefits. The bipartisan bill is simple and straightforward. It removes the prohibition from negotiating discounts with pharmaceutical manufacturers, and requires the Secretary of Health & Human Services to negotiate. This legislation will deliver lower premiums to the seniors, lower prices at the pharmacy and savings for all taxpayers.

It is equally important to understand that this legislation does not do certain things. HR4 does not preclude private plans from getting additional discounts on medicines they offer seniors and people with disabilities. HR4 does not establish a national formulary. HR4 does not require price controls. HR4 does not hamstring research and development by pharmaceutical houses.
HR4 does not require using the Department of Veterans Affairs' price schedule.

Opponents support voting NO because:

Does ideological purity trump sound public policy? It shouldn't, but, unfortunately, it appears that ideology would profoundly change the Medicare part D prescription drug program, a program that is working well, a program that has arrived on time and under budget. The changes are not being proposed because of any weakness or defect in the program, but because of ideological opposition to market-based prices. Since the inception of the part D program, America's seniors have had access to greater coverage at a lower cost than at any time under Medicare.

Under the guise of negotiation, this bill proposes to enact draconian price controls on pharmaceutical products. Competition has brought significant cost savings to the program. The current system trusts the marketplace, with some guidance, to be the most efficient arbiter of distribution.
Status: Cloture rejected Cloture vote rejected, 55-42 (3/5ths required)

Voted NO on limiting medical liability lawsuits to $250,000.

A "cloture motion" cuts off debate. Voting YEA indicates support for the bill as written, in this case to cap medical liability lawsuits. Voting NAY indicates opposition to the bill or a desire to amend it. This bill would "provide improved medical care by reducing the excessive burden the liability system places on the health care delivery system." It would limit medical lawsuit noneconomic damages to $250,000 from the health care provider, and no more than $500,000 from multiple health care institutions.

Proponents of the motion recommend voting YEA because:

Many doctors have had to either stop practicing medicine due to increased insurance premiums.

Patients are affected as well--due to rising malpractice rates, more and more patients are not able to find the medical specialists they need.

The cost of medical malpractice insurance premiums are having wide-ranging effects. It is a national problem, and it is time for a national solution.

I am pleased that
S. 22 extends liability protections to all health care providers and institutions.

These bills are a commonsense solution to a serious problem, and it is time for us to vote up or down on this legislation.

Opponents of the motion recommend voting NAY because:

We have virtually no evidence that caps on economic damages will actually lower insurance rates. And in my view, these caps are not fair to victims.

If we want to reduce malpractice insurance premiums we must address these problems as well as looking closely at the business practices of the insurance companies. What we shouldn't do is limit the recovery of victims of horrible injury to an arbitrarily low sum.

This is obviously a complicated issue. This is the kind of issue that needs to be explored in depth in our committees so that a consensus can emerge. So I will vote no on cloture, and I hope that these bills will go through committees before we begin floor consideration of this important topic.

Voted YES on expanding enrollment period for Medicare Part D.

To provide for necessary beneficiary protections in order to ensure access to coverage under the Medicare part D prescription drug program. Voting YES would extend the 6-month enrollment period for the Prescription Drug Benefit Program to the entire year of 2006 and allows beneficiaries to change plans once in that year, without penalty, after enrollment. Also would fully reimburse pharmacies, states and individuals for cost in 2006 for covered Medicare Part D drugs.

Voted YES on increasing Medicaid rebate for producing generics.

Vote on an amendment that removes an increase in the Medicaid deduction rebate for generic drugs from 11% to 17%. The effect of the amendment, according to its sponsor, is as follows: "This bill eliminates the ability of generic drugs to be sold using Medicaid. Over half the prescription drugs used in Medicaid are generic. Because we have raised the fees so dramatically on what a generic drug company must pay a pharmacy to handle the drug, pharmacies are not going to use the generic. In the long run, that will cost the Medicaid Program billions of dollars. My amendment corrects that situation." A Senator opposing the amendment said: "This bill has in it already very significant incentives for generic utilization through the way we reimburse generics. Brand drugs account for 67% of Medicaid prescriptions, but they also account for 81% of the Medicaid rebates. This is reasonable policy for us, then, to create parity between brand and generic rebates. This amendment would upset that parity."

Vote to adopt an amendment that would allow federal government negotiations with prescription drug manufactures for the best possible prescription drug prices. Amendment details: To ensure that any savings associated with legislation that provides the Secretary of Health and Human Services with the authority to participate in the negotiation of contracts with manufacturers of covered part D drugs to achieve the best possible prices for such drugs under Medicare Part D of the Social Security Act, that requires the Secretary to negotiate contracts with manufacturers of such drugs for each fallback prescription drug plan, and that requires the Secretary to participate in the negotiation for a contract for any such drug upon the request of a prescription drug plan or an MA-PD plan, is reserved for reducing expenditures under such part.

Voted NO on $40 billion per year for limited Medicare prescription drug benefit.

S. 1 As Amended; Prescription Drug and Medicare Improvement Act of 2003. Vote to pass a bill that would authorize $400 billion over 10 years to create a prescription drug benefit for Medicare recipients beginning in 2006. Seniors would be allowed to remain within the traditional fee-for-service program or seniors would have the option to switch to a Medicare Advantage program that includes prescription drug coverage. Private insurers would provide prescription drug coverage. Private Insurers would engage in competitive bidding to be awarded two-year regional contracts by the Center for Medicare Choices under the Department of Health and Human Services.Enrolled seniors would pay a $275 deductible and an average monthly premium of $35. Annual drug costs beyond the deductible and up to $4,500 would be divided equally between the beneficiary and the insurer. Beneficiaries with incomes below 160 percent of the poverty level would be eligible for added assistance.

Voted YES on allowing reimportation of Rx drugs from Canada.

S. 812, as amended; Greater Access to Affordable Pharmaceuticals Act of 2002. Vote to pass a bill that would permit a single 30-month stay against Food and Drug Administration approval of a generic drug patent when a brand-name company's patent is challenged. The secretary of Health and Human Services would be authorized to announce regulations allowing pharmacists and wholesalers to import prescription drugs from Canada into the United States. Canadian pharmacies and wholesalers that provide drugs for importation would be required to register with Health and Human Services. Individuals would be allowed to import prescription drugs from Canada. The medication would have to be for an individual use and a supply of less than 90-days.

Vote to provide federal protections, such as access to specialty and emergency room care, and allow patients to sue health insurers in state and federal courts. Economic damages would not be capped, and punitive damages would be capped at $5 million.

Voted NO on funding GOP version of Medicare prescription drug benefit.

Vote to pass an amendment that would make up to $300 billion available for a Medicare prescription drug benefit for 2002 through 2011. The money would come from the budget's contingency fund. The amendment would also require a Medicare overhaul.

Establish "report cards" on HMO quality of care.

Clinton adopted the manifesto, "A New Agenda for the New Decade":

Promote Universal Access and Quality in Health Care That more than 40 million Americans lack health insurance is one of our society’s most glaring inequities. Lack of insurance jeopardizes the health of disadvantaged Americans and also imposes high costs on everyone else when the uninsured lack preventive care and get treatment from emergency rooms. Washington provides a tax subsidy for insurance for Americans who get coverage from their employers but offers nothing to workers who don’t have job-based coverage.

Markets alone cannot assure universal access to health coverage. Government should enable all low-income families to buy health insurance. Individuals must take responsibility for insuring themselves and their families whether or not they qualify for public assistance.

Finally, to help promote higher quality in health care for all Americans, we need reliable information on the quality of health care delivered by health plans and providers; a “patient’s bill of rights” that ensures access to medically necessary care; and a system in which private health plans compete on the basis of quality as well as cost.

Goals for 2010

Reduce the number of uninsured Americans by two-thirds through tax credits, purchasing pools, and other means.

Create a system of reliable “report cards” on the quality of care delivered by health plans and providers.

Amends the Internal Revenue Code to provide for the exclusion from gross income of amounts received under the National Nursing Service Corps Scholarship Program.

Amends the Public Health Service Act to: (1) develop and issue public service announcements that advertise and promote the nursing profession, highlight the advantages and rewards of nursing, and encourage individuals from diverse communities and backgrounds to enter the nursing profession; and (2) award grants to designated eligible educational entities in order to increase the number of nurses.

Establishes a National Nurse Service Corps Scholarship program that provides scholarships to individuals seeking nursing education in exchange for service by such individuals in areas with nursing shortages. Authorizes appropriations.

Let states make bulk Rx purchases, and other innovations.

As you know, prescription drug costs have been surging at double-digit rates for the last six years. The average annual increase 1999 through 2003 was a massive 16%, seven times the rate of general inflation.

These increases fall hardest on senior citizens and the uninsured. Their health needs are often great, and their low incomes often make these products unaffordable. They have no ability to use their combined purchasing power to negotiate reasonable prices. Taxpayers pay tens of billions of dollars for the purchase of drugs by Medicaid—an expense that could be reduced significantly if states are permitted to negotiate for the best prices from drug manufacturers.

As you know, the Supreme Court has just ruled that Maine's innovative program to reduce prescription drug costs for the uninsured and senior citizens is not a violation of the Medicaid law.
As a result of this decision, Maine can use the combined buying power of Medicaid and individuals purchasing drugs on their own to negotiate lower prices with drug manufacturers. Twenty-nine other states supported the position taken by Maine, and there is broad interest in many states in initiating similar programs.

The Supreme Court's ruling, however, left open the possibility that if the Department of Health and Human Services makes a finding that the Maine program violates the Medicaid statute, the Department's action would be upheld by the Court. We urge you not to intervene to block Maine's program or similar statutes in other states that achieve savings for taxpayers, the elderly, and the uninsured. Such programs must be carefully implemented to assure that the poor are not denied access to needed drugs, but there is no justification for the federal government to deny states the ability to negotiate lower drug prices on behalf of their neediest citizens.

Source: Letter from 30 Senators to the Secretary of HHS 03-SEN6 on May 20, 2003

The American Public Health Association (APHA) is the oldest and largest organization of public health professionals in the world, representing more than 50,000 members from over 50 occupations of public health. APHA is concerned with a broad set of issues affecting personal and environmental health, including federal and state funding for health programs, pollution control, programs and policies related to chronic and infectious diseases, a smoke-free society, and professional education in public health.

The following ratings are based on the votes the organization considered most important; the numbers reflect the percentage of time the representative voted the organization's preferred position.

End government propaganda on Medicare bill.

Clinton signed a letter from 6 Senators to Directors of Television Networks

Recently, the U.S. Department of Health and Human Services (HHS), through a public relations firm, distributed Video News Releases (VNRs) to numerous local television news stations across the country. These VNRs contain pre-scripted news story packages and B-Roll designed to influence local news station to run stories complimentary of the new Medicare law recently signed by President Bush. However, these VNRs may mislead many news stations because they do not identify that they are produced by the government. In addition, these materials are currently being evaluated to determine whether they are illegal "covert propaganda."

We urge you to immediately warn stations not to use these materials and pull any stories that use them.

These tapes can be identified as follows: Two English-language versions begin with B-Roll of video slides promoting the new Medicare law,
followed by interview soundbites from Tommy Thompson, Secretary of the Department of Health and Human Services and Leslie Norwalk, Acting Deputy Administrator of the Centers for Medicare and Medicaid (CMS). Following these soundbites, a complete television news package is run, with a voice-over by a fictional reporter named "Karen Ryan." Following the news package, more B-Roll is provided, including scenes of President Bush's rally at the signing of the bill, scenes from a pharmacy and scenes of seniors playing table games.

It is critical to the credibility of an independent news media that covert government propaganda be rejected for use by news organizations. We also believe that honest government should not resort to such deceptive tactics, and it is our belief that these materials violate the above-mentioned Federal law. Thank you for your cooperation with this request.

Source: Letter from 6 Senators to Directors of Television Networks 04-SEN3 on Mar 15, 2004

Sponsored bill for mental health service for older Americans.

OFFICIAL CONGRESSIONAL SUMMARY: A bill to provide for mental health screening and treatment services, and to provide for integration of mental health services and mental health treatment outreach teams.

SPONSOR'S INTRODUCTORY REMARKS: Sen. CLINTON: This bill is an effort to improve the accessibility and quality of mental health services for our rapidly growing population of older Americans. As we look forward to increased longevity, we must also acknowledge the challenges that we face related to the quality of life as we age. Chief among these are mental and behavioral health concerns.

It is estimated that nearly 20% of Americans age 55 or older experience a mental disorder. It is anticipated that the number of seniors with mental health problems will increase from 4 million in 1970 to 15 million in 2030. Mental disorders do not have to be a part of the aging process because we have effective treatments for these conditions. But in far too many
instances our seniors go undiagnosed and untreated because of the current divide in our country between health care and mental health care.

That is why I am reintroducing the Positive Aging Act. This legislation would strengthen the delivery of mental health services to older Americans. Specifically, the Positive Aging Act would fund grants to states to provide screening and treatment for mental health disorders in seniors. It would also fund demonstration projects to provide these screening and treatment services to older adults residing in rural areas and in naturally occurring retirement communities, NORC's.

I believe that we owe it to older adults in this country to do all that we can to ensure that high quality mental health care is both available and accessible. This legislation takes an important step in that direction.

LEGISLATIVE OUTCOME:Referred to Senate Committee on Health, Education, Labor, and Pensions; never came to a vote.

Improve services for people with autism & their families.

Clinton sponsored improving services for people with autism & their families

Amends the Public Health Service Act to require the Secretary of Health and Human Services to:

convene, on behalf of the Interagency Autism Coordinating Committee, a Treatments, Interventions, and Services Evaluation Task Force to evaluate evidence-based biomedical and behavioral treatments and services for individuals with autism;

establish a multi-year demonstration grant program for states to provide evidence-based autism treatments, interventions, and services.

establish planning and demonstration grant programs for adults with autism;

award grants to states for access to autism services following diagnosis;

award grants to
University Centers of Excellence for Developmental Disabilities to provide services and address the unmet needs of individuals with autism and their families;

make grants to protection and advocacy systems to address the needs of individuals with autism and other emerging populations of individuals with disabilities; and

award a grant to a national nonprofit organization for the establishment and maintenance of a national technical assistance center for autism services and information dissemination.

Directs the Comptroller General to issue a report on the financing of autism services and treatments.

Establish a national childhood cancer database.

Conquer Childhood Cancer Act of 2007 - A bill to advance medical research and treatments into pediatric cancers, ensure patients and families have access to the current treatments and information regarding pediatric cancers, establish a population-based national childhood cancer database, and promote public awareness of pediatric cancers.

Authorizes the Secretary to award grants to childhood cancer professional and direct service organizations for the expansion and widespread implementation of:

activities that provide information on treatment protocols to ensure early access to the best available therapies and clinical trials for pediatric cancers;

activities that provide available information on the late effects of pediatric cancer treatment to ensure access to necessary long-term medical and psychological care; and

direct resource services such as educational outreach for parents, information on school reentry and postsecondary education, and resource directories or referral services for financial assistance, psychological counseling, and other support services.

Legislative Outcome: House version H.R.1553; became Public Law 110-285 on 7/29/2008.

Preserve access to Medicaid & SCHIP during economic downturn.

A bill to preserve access to Medicaid and the State Children's Health Insurance Program during an economic downturn.

Economic Recovery in Health Care Act of 2008 - Prohibits finalizing, implementing, enforcing, or otherwise taking any action, prior to April 1, 2009, on any changes to Medicaid programs or State Children's Health Insurance Program (SCHIP).

Amends the U.S. Troop Readiness, Veterans' Care, Katrina Recovery, and Iraq Accountability Appropriations Act of 2007 to extend through April 1, 2009, the moratorium relating to the cost limit for providers.

Amends the Medicare, Medicaid, and SCHIP Extension Act of 2007 to extend through April 1, 2009, the moratorium relating to rehabilitation services, school-based administration, and school-based transportation.

Provides for state fiscal relief through a temporary increase of Medicaid federal medical assistance percentage (FMAP).